Official websites use. Share sensitive information only on official, secure websites. Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee.
This process was conducted independently of any industry funding. We used the GRADE system to guide assessment of quality of evidence from high A to very low D and to determine the strength of recommendations.
A strong recommendation [ 1 ] indicates that an intervention's desirable effects clearly outweigh its undesirable effects risk, burden, cost , or clearly do not. Weak recommendations [ 2 ] indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence.
In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. Recommendations specific to pediatric severe sepsis include: greater use of physical examination therapeutic end points 2C ; dopamine as the first drug of choice for hypotension 2C ; steroids only in children with suspected or proven adrenal insufficiency 2C ; a recommendation against the use of recombinant activated protein C in children 1B.
There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients. Severe sepsis acute organ dysfunction secondary to infection and septic shock severe sepsis plus hypotension not reversed with fluid resuscitation are major healthcare problems, affecting millions of individuals around the world each year, killing one in four and often more , and increasing in incidence [ 1 β 5 ].
